Rashtriya Bal Swasthya Karyakram (RBSK)

What is Rashtriya Bal Swasthya Karyakram?

Rashtriya Bal Swasthya Karyakram (RBSK) is a child health screening and early intervention programme run by the Ministry of Health and Family Welfare under the National Health Mission. RBSK was launched in February 2013 and works on a simple principle: many childhood conditions that cause lifelong disability are cheap and easy to fix if they are found early, and expensive or impossible to fix if they are found late.

According to the National Health Mission, RBSK screens children from birth to 18 years for 30 health conditions grouped under four headings known as the 4Ds: defects at birth, deficiencies, diseases and developmental delays including disability. Every stage of the pathway; screening, confirmation of diagnosis, management at a District Early Intervention Centre and tertiary treatment including surgery: is free to the family.

RBSK is not a cash transfer and there is no application form. The programme takes services to the child rather than asking the family to come forward.

Key objectives

• Detect birth defects, deficiencies, diseases and developmental delays as early as possible, ideally in the newborn period.
• Reduce child mortality and, just as importantly, reduce avoidable disability among children who survive.
• Provide a free, unbroken referral chain from the village to a tertiary hospital so that a poor family is never stopped by cost.

Who is covered under RBSK?

Children who can be screened:

• Newborns at public health facilities and delivery points; screened for birth defects before discharge by the nurse or medical officer.
• Newborns at home, visited by the ASHA worker under Home Based Newborn Care, who refers any child she suspects of having a defect.
• Pre-school children aged 6 weeks to 6 years at anganwadi centres; screened by the RBSK mobile health team twice a year.
• Children aged 6 to 18 years in government and government-aided schools; screened by the mobile health team once a year.

RBSK covers all these children regardless of family income, caste or ration card category. There is no income ceiling and no BPL requirement.

Who is not eligible or not routinely reached:

• Children above 18 years are outside the age range of the programme.
• Children enrolled only in private, unaided schools are not part of the routine annual school screening rounds, which target government and government-aided schools and anganwadi centres. Such a child can still be taken to the district DEIC through the block medical officer.
• Adults, including parents, cannot apply for a personal benefit under RBSK. RBSK is a child health service, not a family cash scheme.
• Screening is not a claim you file. There is no beneficiary list to get your name on, and no agent can add a child to RBSK for a fee.

What conditions does RBSK screen for?

RBSK screens for 30 conditions under the 4Ds. Several states also screen optionally for sickle cell disease, beta thalassaemia and congenital hypothyroidism where facilities exist.

How to apply for RBSK screening and referral

1. Wait for the screening round, or ask for one. The RBSK mobile health team visits your anganwadi centre twice a year and your government school once a year. The anganwadi worker or class teacher is told the date in advance. If you want a child seen sooner, ask the ASHA worker or the anganwadi worker to record the concern.
2. Attend the screening. The team: normally two Ayush medical officers, an ANM or staff nurse and a pharmacist — examines the child using the RBSK screening tools and records the findings in the child's health card.
3. Collect the referral card if the child is found to have one of the 4D conditions. The card names the condition suspected and the facility to report to.
4. Report to the referral facility named on the card. For most conditions this is the block Community Health Centre or the District Early Intervention Centre (DEIC) at the district hospital or medical college.
5. Get the diagnosis confirmed at the DEIC. The DEIC team; paediatrician, physiotherapist, audiologist and speech therapist, psychologist, optometrist, dental and social work staff, assesses the child and starts management.
6. Accept the onward referral for tertiary care if surgery or specialist treatment is needed. The DEIC arranges admission at a government tertiary hospital or an empanelled private hospital. Treatment is free.
7. Return for follow-up on the dates given. Conditions such as clubfoot, hearing loss and developmental delay need repeated sessions, and results depend on completing them.

Newborns follow a shorter version of the same path: screening at the delivery point before discharge, or by the ASHA worker during home visits in the first six weeks, then direct referral to the DEIC.

What does RBSK cost the family?

Nothing. Screening, DEIC assessment, therapy sessions and tertiary treatment including surgery are provided free of cost under the National Health Mission. Families should not pay any charge for an RBSK referral, and no fee is payable for a referral card. Report demands for payment to the district RBSK nodal officer or on the state health helpline.

How large is RBSK?

RBSK is one of the largest child screening programmes anywhere. Ministry of Health and Family Welfare figures for the period 2014-15 to 2023-24 report about 160 crore child screenings carried out through roughly 11,800 mobile health teams, with more than 5 crore children receiving secondary or tertiary level treatment after referral. The exact number of mobile health teams and DEICs varies by state; Tamil Nadu, for example, runs 805 teams and 34 DEICs.

Why an RBSK referral can stall, and how to keep it moving

A screening finding only helps if the child actually reaches treatment, and the referral chain is where families most often lose momentum. The commonest reasons a referral stalls are practical rather than medical: the family never travels to the District Early Intervention Centre named on the referral card, the card is lost before the DEIC visit, or the child is not brought back for the follow-up sessions that conditions like clubfoot, hearing loss and developmental delay need. Keep the referral card safe, note the DEIC address on it, and treat the first DEIC appointment as urgent; early intervention works best when it starts young. If distance or wage loss is the obstacle, tell the ASHA worker or the DEIC manager, since transport support and admission arrangements are part of the programme and are meant to remove exactly these barriers.

A second stall point is the paperwork for tertiary surgery. Conditions such as congenital heart disease and cleft lip and palate are treated at government tertiary hospitals or empanelled private hospitals, and admission needs the referral card plus a parent's identity proof. Ask the DEIC manager to complete the referral formalities and confirm which hospital the child is being sent to before you travel, so you are not turned away for missing documents.

Newborn screening: the earliest and most important round

Newborns are the priority group under RBSK, because birth defects found in the first days of life are the ones where early treatment changes a child's whole future. According to the National Health Mission, screening begins at the delivery point before the baby is discharged, and continues through the ASHA worker's home visits under Home Based Newborn Care during the first six weeks. Conditions the newborn round looks for include neural tube defect, Down syndrome, cleft lip and palate, clubfoot, developmental dysplasia of the hip, congenital cataract, congenital deafness, congenital heart disease and retinopathy of prematurity in babies born preterm. A newborn suspected of any of these is referred straight to the DEIC rather than waiting for a later anganwadi round, so a mother who notices anything unusual should raise it with the ASHA worker or the delivery-point staff immediately rather than waiting for the next scheduled visit.

Where to get help with RBSK

• State health helpline: 104, for advice, facility information and complaints about a public health facility. This is a 24x7 toll-free line run under the National Health Mission.
• ASHA worker or anganwadi worker in your village or ward, the first point of contact for getting a child listed for screening.
• District Early Intervention Centre at your district hospital or government medical college, for assessment, therapy and referral paperwork.
• District RBSK nodal officer, through the Chief Medical Officer's office, for delays, refused referrals or demands for payment.
• RBSK portal: rbsk.mohfw.gov.in

If a child has already been diagnosed elsewhere with a condition on the 4D list, take the existing reports to the DEIC. A prior private diagnosis does not disqualify a child from free treatment under RBSK.